What the study investigated
Researchers examined whether remdesivir (RDV), given during a COVID-19 hospitalization, is associated with reduced mortality after discharge among survivors. Using real-world data from three large health systems in Colorado and Utah, the study followed patients who survived their index hospitalization for 6 to 29 months to assess long-term outcomes beyond the initial admission.
Study design and data sources
The analysis combined electronic health records from UCHealth, Denver Health, and Intermountain Health with state vaccination and mortality records from Colorado and Utah. The primary cohort included adults (18+) who were hospitalized for COVID-19 between late 2020 and late 2022, survived the hospitalization, and had complete data. Those who received outpatient antivirals after hospitalization or who died during the index hospitalization were excluded, leaving 9,760 survivors for the core analysis. The researchers used Cox proportional hazards models to estimate the risk of all-cause mortality after discharge, comparing those who received inpatient RDV to those who did not. They performed multiple sensitivity analyses, including propensity-matching to address potential biases.
Key findings on long-term mortality
Among survivors, inpatient RDV was associated with a lower risk of death after discharge. The adjusted hazard ratio (aHR) for post-discharge mortality was 0.73 (95% CI 0.61–0.87) for those treated with RDV, over follow-up up to 29 months. Sensitivity analyses that treated in-hospital mortality as a competing risk yielded a similar protective effect (aHR 0.76; 95% CI 0.63–0.92). In addition to reduced mortality, RDV treatment was linked to fewer 28-day post-discharge hospital readmissions (aHR 0.77; 95% CI 0.67–0.89) and fewer ED visits (aHR 0.79; 95% CI 0.67–0.92).
Who benefits most and study caveats
The study’s subgroup analyses suggested most patients benefited, including those who required some oxygen during their index hospitalization. However, potential exceptions included patients infected during the first Omicron wave, those who had received at least one vaccine dose, and those who did not require supplemental oxygen. Vaccination status appeared to modify the RDV effect, with less clear benefit among previously vaccinated individuals. The authors highlight several limitations: missing data on corticosteroid or other in-hospital treatments, survivor bias from excluding those who died in-hospital, and lack of information on RDV treatment duration and timing relative to symptom onset. These factors may influence the observed association between inpatient RDV and long-term outcomes.
Implications for clinicians and patients
This real-world study suggests that RDV, when given during hospitalization to survivors, might be associated with better long-term survival and reduced early post-discharge healthcare use. While causality cannot be established in an observational design, the consistency across analyses supports considering RDV as part of comprehensive care for eligible hospitalized patients, particularly those at higher risk of adverse long-term outcomes. Further research is needed to understand the biological mechanisms driving this association and to identify which patients stand to benefit most.
Bottom line
In a large real-world cohort from Colorado and Utah, inpatient remdesivir use among survivors of COVID-19 hospitalization was associated with reduced long-term mortality, along with lower rates of 28-day re-hospitalization and ED visits. As with all observational work, results should be weighed alongside randomized trial data and individual patient factors.
